What is Door-to-Balloon Time?

Cath lab

For every single minute a person waits between the time they first feel symptoms of a heart attack to the time they are treated, heart cells could be irreversibly dying. This organ that is synonymous with life, and keeps the other organs of our bodies functioning to their fullest capacity, is a pretty important one - when it comes to a heart attack, do not hesitate. Time is truly of the essence. From the minute symptoms begin, an imaginary clock starts ticking.

Heart attacks are caused by blocked coronary arteries, which limit or completely stop blood supply to part of the heart. Oxygen cannot reach the blocked part of the heart and the muscle suffers and begins to die There are a number of different medical terms used to describe a heart attack: two important phrases are STEMI and non-STEMI heart attack. A STEMI (ST-elevation myocardial infarction) is when the coronary artery is completely blocked, while a non-STEMI heart attack involves partial blockage of the artery. A STEMI heart attack is associated with the greatest risk of death or disability, so it is absolutely vital that the blocked artery is reopened as quickly as possible to restore blood flow.


Mission: Lifeline is a program developed by the American Heart Association to speed up the process of diagnosing and treating STEMI heart attacks by providing the best possible care. The program coordinates care between EMS, ambulance companies, hospitals and other healthcare providers to get patients the care they need as quickly as possible.

Door-to-balloon time is a key performance quality metric in the treatment of heart attacks. The American Heart Association’s guidelines recommends that the artery be reopened within 90 minutes for best patient outcomes. This 90 min period of time can be thought of as three 30-minute increments:

  • 30 minutes from the time symptoms start to the time the patient has engaged medical care, a diagnosis of STEMI has been made and the cardiac cath team is alerted.
  • 30 minutes from cardiology team mobilization to patient arrival in the cardiac cath lab.
  • 30 minutes from start of the procedure to the opening of the blocked artery.*

*Time from first medical contact to balloon time can be even less than 90 min if the patient makes a call to 911 early on.

If you’re feeling chest pain, pressure, squeezing or shortness of breath, call 911 immediately. “Don’t hesitate to call emergency services when you have chest pain,” explains Michelle Walsh, Heart and Vascular Performance Improvement Outcomes Specialist at Penn Medicine, “the longer you wait, the longer the heart attack continues”. Driving yourself to the emergency room is not only a hazard, but it wastes precious time. When Emergency Medical Services arrive to a patient’s location, they are prepared to perform an electrocardiogram in the field, and can even remotely transmit that data to the hospital. This EKG is used to help diagnose a heart attack. “If it is confirmed that a patient is having a heart attack, they can alert the cardiology team before a heart attack patient even arrives at the hospital, saving time,” says Michelle.

Coordinating Care

EMS teams know which hospitals are best equipped to treat a STEMI heart attack; this is not necessarily the closest hospital and making this choice can be lifesaving. The preferred method for opening the artery is called percutaneous coronary intervention (PCI), which uses stents, angioplasty or another mechanical or surgical intervention. Though this is the best way to treat a STEMI, the American Heart Association estimates that “only about 39% of U.S. hospitals have the equipment, expertise and facilities to deliver this type of treatment.”Pennsylvania Hospital Cath Lab

Penn Medicine is one such location, and our team actively engages with the city of Philadelphia, first responders and other health systems to ensure the best possible care for patients. We also work closely with the American Heart Association to ensure we are meeting the 90-minute standard established by Mission: Lifeline, and to continue refining the process and reducing the door-to-balloon time.

Over 1 million people in the United States suffer a heart attack every year and of those, about one third of them die. While preventing heart attacks through decreasing modifiable risk factors is a top priority of ours, so is being able to offer the best care possible to those patients and families that are experiencing an acute cardiac event. But it all starts with recognizing the symptoms and making the first call in the chain of care - the call to 911. Maybe it will turn out to be nothing, but if it turns out to be something, you will be glad you called when you did.

About this Blog

The Penn Heart and Vascular blog provides the latest information on heart disease prevention, nutrition and breakthroughs in cardiovascular care.

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